Strategies for repeat prostate biopsies.

Urologists are routinely faced with the dilemma of a persistently worrisome clinical picture for prostate cancer in patients who have undergone prior negative ultrasound-guided prostate biopsies. Indications for repeat biopsy include sustained or worsening of the findings that prompted the initial biopsy; various derivations of prostate-specific antigen; and the histology from the initial biopsy (ie, high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation is identified). Large prostate volume or inflammation can confound the decision to perform repeat biopsies.

Race and time from diagnosis to radical prostatectomy: does equal access mean equal timely access to the operating room?--Results from the SEARCH database.

Background: African American men with prostate cancer are at higher risk for cancer-specific death than Caucasian men. We determine whether significant delays in management contribute to this disparity. We hypothesize that in an equal-access health care system, time interval from diagnosis to treatment would not differ by race.

Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database.

The literature contains conflicting data on preoperative predictors of estimated blood loss (EBL) at radical retropubic prostatectomy (RRP). We sought to examine preoperative predictors of EBL at the time of RRP among patients from the SEARCH database to lend clarity to this issue. A total of 1154 patients were identified in the SEARCH database who underwent RRP between 1988 and 2008 and had EBL data available.

Exposure to Agent Orange is a significant predictor of prostate-specific antigen (PSA)-based recurrence and a rapid PSA doubling time after radical prostatectomy.

Objective: To investigate and report the clinicopathological characteristics and outcomes after radical prostatectomy (RP) in patients with prostate cancer and previous exposure to Agent Orange (AO), particularly in relationship to race.

Patients And Methods: In 1495 veterans who had undergone RP the clinicopathological characteristics, biochemical progression rates, and prostate-specific antigen (PSA) doubling time (DT) after recurrence between AO-exposed and unexposed men were compared using logistic and linear regression and Cox proportional hazards analyses, and stratified by race.

Results: The 206 (14%) men with AO exposure were more likely to be black (P = 0.

Do nomograms predict aggressive recurrence after radical prostatectomy more accurately than biochemical recurrence alone?

Objective: To compare the predictive accuracy (PA) of existing models in estimating risk of biochemical recurrence (BCR) vs aggressive recurrence (BCR with a prostate-specific antigen, PSA, doubling time, DT, of <9 months).

Patients And Methods: The study included 1550 men treated with radical prostatectomy (RP) between 1988 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The PA of nine different risk stratification models for estimating risk of BCR and risk of aggressive recurrence after RP was assessed using the concordance index, c.

The use of Urovysion fluorescence in situ hybridization in the diagnosis and surveillance of non-urothelial carcinoma of the bladder.

Urovysion fluorescence in situ hybridization (FISH) is a sensitive and specific test used to diagnose urothelial carcinoma in urine. It detects aneuploidy of chromosomes 3, 7 and 17, and loss of both 9p21 loci in malignant urothelial cells. We evaluated Urovysion FISH in non-urothelial carcinoma involving bladder to determine its possible application to their diagnosis and surveillance.

What are the factors associated with short prostate specific antigen doubling time after radical prostatectomy? A report from the SEARCH database group.

Purpose: Short prostate specific antigen doubling time following recurrence after radical prostatectomy portends a poor prognosis in men with prostate cancer. We determined which demographic and clinicopathological variables were predictive of a short prostate specific antigen doubling time in a cohort of men with clinically localized prostate cancer treated with radical prostatectomy.

Materials And Methods: Data on 856 men from the Shared Equal Access Regional Cancer Hospital database who underwent radical prostatectomy for node negative prostate cancer between 1988 and 2003 were included in the analysis.

The association between prostate size and Gleason score upgrading depends on the number of biopsy cores obtained: results from the Shared Equal Access Regional Cancer Hospital Database.

Objective: To test the hypothesis that the association between prostate size and risk of Gleason grade upgrading varies as a function of sampling.

Patients And Methods: We examined the association between pathological prostate weight, prostate biopsy scheme and Gleason upgrading (Gleason > or =7 at radical prostatectomy, RP) among 646 men with biopsy Gleason 2-6 disease treated with RP between 1995 and 2007 within the Shared Equal Access Regional Cancer Hospital Database using logistic regression. In all, 204 and 442 men had a sextant (six or seven cores) or extended-core biopsy (eight or more cores), respectively.

Obesity and positive surgical margins by anatomic location after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital database.

Objectives: To determine if there is predilection for any specific anatomical location of positive surgical margins (PSMs) after radical prostatectomy (RP) for prostate cancer in obese men, as previous studies found that obesity was associated with an increased risk of PSMs.

Patients And Methods: We analysed retrospectively 1434 men treated with RP between 1989 and 2007 within the Shared Equal Access Regional Cancer Hospital database. The association between increased body mass index (BMI) and overall and site-specific PSMs was assessed using multivariate logistic regression.

Obesity and oncological outcome after radical prostatectomy: impact of prostate-specific antigen-based prostate cancer screening: results from the Shared Equal Access Regional Cancer Hospital and Duke Prostate Center databases.

Objective: To indirectly test the hypothesis that prostate-specific antigen (PSA)-based screening is biased against obese men due to haemodilution of PSA, and thus results in delayed diagnosis and poorer outcome beyond the biological link between obesity and aggressive prostate cancer.

Patients And Methods: We sought to examine the association between body mass index (BMI) and the outcome of radical prostatectomy (RP) separately for men with PSA-detected cancers (cT1c) or with abnormal digital rectal examination (DRE) findings (cT2/T3), and stratified by year of treatment, using two large databases. We conducted a retrospective cohort study of 1375 and 2014 men treated by RP between 1988 and 2007 using the Shared Equal Access Regional Cancer Hospital (SEARCH) and Duke Prostate Center (DPC) databases.

Impact of nerve sparing on surgical margins and biochemical recurrence: results from the SEARCH database.

The effects of nerve sparing on the risk of positive surgical margins (PSMs) and biochemical recurrence after radical prostatectomy (RP) remain controversial. We examined data from 1018 men treated by RP between 1988 and 2006 at five centers in the Shared Equal Access Regional Cancer Hospital database. Neither bilateral nor unilateral nerve-sparing techniques were associated with a higher risk of PSM; on multivariate analysis of individual sides, the risk of PSM on either side was not increased by nerve sparing on either side.

Limitations of prostate specific antigen doubling time following biochemical recurrence after radical prostatectomy: results from the SEARCH database.

Purpose: Prostate specific antigen doubling time following biochemical recurrence after radical prostatectomy is a powerful predictor of prostate cancer specific and overall death. To calculate prostate specific antigen doubling time requires multiple prostate specific antigen determinations that are unaltered by secondary therapy and separated by sufficient time. Physicians and patients may be unwilling to wait before starting secondary therapy, especially for high risk recurrences.

Risk stratification for biochemical recurrence in men with positive surgical margins or extracapsular disease after radical prostatectomy: results from the SEARCH database.

Purpose: In men with extracapsular disease or positive surgical margins after radical prostatectomy immediate adjuvant therapy decreases the risk of biochemical recurrence at the cost of increased toxicity. We further stratified these men into a low risk group in which watchful waiting after surgery may be preferred and a high risk cohort in which adjuvant therapy may be preferred.

Materials And Methods: We performed a retrospective analysis of the records of 902 men treated with radical prostatectomy in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database between 1988 and 2007 with positive surgical margins and/or extracapsular disease without seminal vesicle invasion or lymph node metastasis.

Effect of advanced age on the development of complications from intravesical bacillus Calmette-Guérin therapy.

Purpose: Advanced age is considered a risk factor for complications in patients receiving intravesical bacillus Calmette-Guérin (BCG) therapy. However, there is no clear delineation of BCG-related complication rates relative to patient age.

Materials And Methods: We reviewed the clinical course of 58 consecutive men receiving maintenance BCG therapy from December 1999 to July 2004 for transitional cell carcinoma.

The effect of race/ethnicity on the accuracy of the 2001 Partin Tables for predicting pathologic stage of localized prostate cancer.

Objectives: To test the accuracy of the 2001 Partin Tables in African American men who underwent radical prostatectomy at multiple centers throughout the United States.

Methods: We compiled a large multiethnic cohort of men (n = 3748) treated with radical prostatectomy at multiple sites, including all of the sites of the Department of Veterans Affairs-based Shared Equal Access Regional Cancer Hospital (SEARCH) database (n = 1524), Wayne State University (n = 1305), the University of Texas Health Science Center (n = 522), and the Henry Ford Hospital (n = 397). We evaluated the accuracy of the 2001 Partin Tables using area under the receiver operator characteristic curve (AUC) separately among African American and white men.

Small transrectal ultrasound volume predicts clinically significant Gleason score upgrading after radical prostatectomy: results from the SEARCH database.

Purpose: Needle biopsy Gleason scores are often upgraded after pathological examination of the prostate following radical prostatectomy. It has been suggested that larger prostates would be associated with a greater risk of upgrading since a smaller percentage of the gland is sampled and, thus, the highest grade disease would more likely be missed, assuming an equal number of cores is taken from similar locations. We examined the likelihood of clinically relevant upgrading after radical prostatectomy as a function of transrectal ultrasound volume.

Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer.

Context: Recent studies have suggested that obese men have lower serum prostate-specific antigen (PSA) concentrations than nonobese men. Because men with higher body mass index (BMI) have greater circulating plasma volumes, lower PSA concentrations among obese men may be due to hemodilution.

Objective: To determine the association between hemodilution and PSA concentration in obese men with prostate cancer.

Is a positive bladder neck margin truly a T4 lesion in the prostate specific antigen era? Results from the SEARCH Database.

Purpose: Positive bladder neck margins after radical prostatectomy are currently designated as pT4 lesions. However, to our knowledge the prognostic significance of a positive bladder neck margin in the prostate specific antigen era is unknown. We examined the association between positive bladder neck margins and prostate specific antigen recurrence relative to other pathological findings.

High yield of saturation prostate biopsy for patients with previous negative biopsies and small prostates.

Objectives: Men with previously negative prostate biopsies but continued suspicion for carcinoma present a diagnostic dilemma often managed by saturation prostate biopsy (SPB). We sought to determine the patient characteristics for which repeat biopsy by SPB provides the greatest utility for prostate cancer detection.

Methods: The records of the men at the state hospital and affiliated Veterans Affairs Medical Center with previously negative prostate biopsy findings who had then undergone SPB were reviewed.

Race, biochemical disease recurrence, and prostate-specific antigen doubling time after radical prostatectomy: results from the SEARCH database.

Background: Whether black men are at increased risk for biochemical disease recurrence after radical prostatectomy (RP) is debatable. Once black men have developed disease recurrence, it is unknown whether they have more aggressive disease than white men. To address this issue, the authors examined racial differences in pathologic features, time to disease recurrence, and prostate-specific antigen (PSA) doubling time (PSADT) among a cohort of patients treated with RP.

PSA in the new millennium: a powerful predictor of prostate cancer prognosis and radical prostatectomy outcomes--results from the SEARCH database.

Objectives: As a result of prostate-specific antigen (PSA) screening, most men today with prostate cancer present with localized disease and serum PSA values < 10 ng/ml. Within this context, it is debated whether PSA remains an important prognostic variable in more recently treated patients. We examined the prognostic significance of preoperative PSA to predict pathologic stage and biochemical progression among men undergoing radical prostatectomy in the new millennium (2000-2006).

Risk stratification of men with Gleason score 7 to 10 tumors by primary and secondary Gleason score: results from the SEARCH database.

Objectives: Gleason score 4+3 prostate cancer is associated with worse clinicopathologic outcomes than is Gleason score 3+4. Whether the increased risk associated with Gleason score 4+3 disease is equivalent to that of Gleason score 4+4 or greater is unclear.

Methods: We reviewed the data from two separate cohorts pulled from the Shared Equal Access Regional Cancer Hospital database.

Predicting unilateral prostate cancer based on biopsy features: implications for focal ablative therapy--results from the SEARCH database.

Purpose: For men with low risk prostate cancer it was recently proposed that ablative treatment to the affected side may decrease morbidity, while maintaining good oncological outcomes. However, few studies have assessed the correlation between biopsy parameters and pathological outcome (unilateral vs bilateral disease).

Materials And Methods: Using the Shared Equal Access Regional Cancer Hospital Database of men treated with radical prostatectomy at multiple equal access medical centers we retrospectively examined the records of 261 men with clinical stage T1c or T2a prostate cancer, prostate specific antigen less than 10 ng/ml, Gleason sum 6 or less and only 1 or 2 ipsilateral positive cores on at least sextant biopsy.